Gallup has been conducting polls on the U.S. healthcare system since 1994. Essentially all polls since then have indicated that 65% to 73% of the U.S. adult population believes that the current system is "in a state of crisis" or having "major problems." Their poll of 2018-DEC shows the value at 70%. The poll was taken just after the midterm elections when many Democratic candidates had highlighted concerns with the system.

However there has been considerable movement since 2016 within political parties:

Among Republicans and Republican leaners, concern has dropped from 80% in 2016 to 71% in 2017 to 56% in 2018. It is currently as low as it has ever been since the year 2004.

Among Democrats and Democratic leaners, concern has increased from 63%% in 2016 to 76% in 2017 to 84% in 2018. It is currently as high value as it has ever been since since the year 2009.

Only 55% of U.S. adults rate the healthcare system positively. They consider cost and access as its greatest deficiencies.

The poll's margin of sampling error is ±4 percentage points.15

2018-DEC-10: President Trump's poll ratings:

According to a Fox News poll of 1,006 randomly selected registered voters nationwide, if a presidential election were held immediately, 38% of voters would vote to re-elect Donald Trump, while 55% would vote for someone else. 14 These data are certain to have shifted by the time of the next election in 2020-NOV. The poll's margin of error is ±3%.

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U.S. District Judge Reed O’Connor of the United StatesDistrict Court for the Northern District of Texas declared the individual coverage mandate unconstitutional and that the entire law is unconstitutional as a result. However, he did not declare an injunction. Therefore, the law remains in place for now. 13 The "individual coverage mandate" requires most Americans to have at least a basic level of health insurance coverage. The rationale behind the mandate was that if it were not in place then many people in good health would take a risk and not carry insurance. A percentage of them would have significant medical problems and be unable to pay for medical care.

In his ruling, Judge O'Connor stated that the:

"Individual Mandate can no longer be fairly read as an exercise of Congress's Tax Power and is still impermissible under the Interstate Commerce Clause -- meaning the Individual Mandate is unconstitutional. ... "[The mandate is] essential to and inseverable from the remainder of the ACA."13

California is leading a group of 17 Democratic-led states who intend to appeal the decision to the U.S. Court of Appeals for the Fifth Circuit. They said that eliminating Obamacare or the protection of those with pre-existing conditions would harm millions of Americans. California Attorney General Xavier Becerra issued a statement saying:

"Today's ruling is an assault on 133 million Americans with preexisting conditions, on the 20 million Americans who rely on the ACA's consumer protections for healthcare, [and] on America's faithful progress toward affordable healthcare for all Americans. The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court."13

Texas Attorney General Ken Paxton issued a statement saying:

"Today's ruling enjoining Obamacare halts an unconstitutional exertion of federal power over the American health care system while our multi state coalition lawsuit works its way through the courts. Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the failed social experiment with a plan that ensures Texans and all Americans will again have greater choice about what health coverage they need and who will be their doctor."

Barbara McAneny, president of the American Medical Association. issued a statement saying:

"Today's decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans. It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction.

President Trump tweeted:

"As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!"13

He later said:

"Let's say repeal and replace, handled a little bit differently, but it was a big, big victory by a highly respected judge."13

The House leader Nancy Pelosi (D) said:

"Republicans are fully responsible for this cruel decision and for the fear they have struck into millions of families across America who are now in danger of losing their health coverage. When House Democrats take the gavel, the House of Representatives will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans' effort to destroy the Affordable Care Act."13

A casual observer would probably think that these two politicians were discussing two different acts.

Professor Tim Jost, of Washington and Lee University in Lexington VA, said:

"The Trump administration only asked that the individual mandate and provisions protecting individuals with pre-existing conditions be invalidated, but O'Connor's order would invalidate many provisions of the Medicaid program, the Medicare program and other federal laws. ... Judge O'Connor has declared the individual mandate unconstitutional and the rest of the Affordable Care Act invalid, but he has not blocked its continued operation."

Webmaster's personal thoughts on health care:

I was born in Toronto, Canada and have always lived in the Province of Ontario, on the North shore of Lake Ontario across from Rochester, NY. I am 82.1 years old. As of 2018, the average life expectancy in Canada is 82.3 years and has been steadily growing since at least 1960. In the U.S. it is 78.7 years and has been dropping since 2015. This has been the longest sustained decline since the 1910's with its World War 1 and world-wide pneumonia epidemic. The current decline has been attributed to opioid medications and illegal drug consumption. 17

I find it strange that few if any media accounts of this event included an estimate of how many additional Americans would die unnecessarily early if the Affordable Care Act were terminated by the courts or Congress. Similarly, few if any articles indicate an estimate of how many additional person-years of life would be enjoyed by Americans if universal health care were introduced across the U.S.

I suspect that the latter is in excess of a billion person-years! Curiously, I don't know of any Pro-Life groups promoting universal health care. They all seem to be concentrating on the loss of life before birth, rather than newborns, children, youths, young adults, and the elderly.

I wish more people in the U.S. would familiarize themselves with the health care laws across the border in Canada. There, everyone is given health care at birth. Canada's system has resulted in lower overall health care costs, universal coverage for everyone, high regard by the public towards the health care system, and -- perhaps most important -- longer life expectancy.

2019-MAR-11: Trump Administration's 2020 budget:

The budget prioritizes funding of a wall on the border with Mexico. It also reduces funding for healthcare with:

Only a very small increase in funding to combat opiods.

A 5 billion dollar cut in the 2020 National Institutes of Health (NIH) budget.

An repeal of the Affordable Care Act with no replacement.

Reduce the Medicare budget by $845 billion over the next decade.

In addition, there would be:

$8.6 billion for the border wall.

Major eductions to the funding of the Department of Transport, to the SNAP program that provides nutritional aid to millions, and to student aid.

A reduction of the Environmmental Protection Agency budget by almost one third.

A reduction of renewable energy research by more than two thirds. 18,19

2019-APR-10: Democratic candidate for the Presidency, Senator Bernie Sanders (I-VA) introduces his Medicare for All Act:

For his run for the presidency in 2020, Sanders updated his proposal for a single payer health care system. If implemented, it would implement a single-payer system over a four-year interval. It would lower the age at which adults would qualify for Medicare by a decade each year: to 55, 45, 35 ... It would also include home and community-based long-term care services. It would include mental health, vision, and dental care, emergency transportation and substance abuse treatment, His bill is supported by 14 Senators, all Democrats, The Indian Health Service and the Department of Veterans Affairs services would both remain independent for at least a decade. Participating health care providers would have to agree to not discriminate against patients on the basis of their race, national origin, religion, age, sex, sexual orientation, income, disability, or illness.

Persons who enroll in the proposed plan would have to pay the first $200 each year for prescriptions. But other premiums and deductibles would be eliminated. It would also terminate the existing Hyde Amendment which bans federal funds covering most abortion procedures.

2019-APR-30: ‘Medicare For All’ is getting a hearing:

As the healthcare system in the U.S. now stands, its costs per person may be greater than that of any other developed country, and yet the average sick person has limited coverage.

Jonathan Cohn & Jeffrey Young, writing for Huffington Post, said:

"Even many people with insurance today struggle with premiums or out-of-pocket costs, threatening them with catastrophe if they get really sick. And the problem isn’t going to get better on its own. ..."

"No major effort to expand health insurance coverage is going to become law until President Donald Trump is gone from the White House and Republicans lose their grip on the Senate. That can’t happen until 2021 [-JAN], at the earliest, and advocates have already done a lot of work to flesh out their idea." 21

Upgrading the U.S. system to the level found in other developed countries is gradually developing momentum, following Sen. Bernie Sanders (I-VT) 2016 presidential campaign. There is a lot of opposition to the idea because many view a single, universal, government-run insurance plan is a form of socialism. It is being sold as "Medicare for All." in the hope that the high public regard for Medicare could make a universal plan more acceptable.

"Medicare for All" will get a full committee hearing on APR-30.

2019-APR-30: "Medicare for America" bill:

According to American Progress Action:

"Rep. Rosa DeLauro (D, CT) and others will re-introduce their Medicare for America plan this week, providing another path to universal coverage based in part on ... [Center for American Progress'] ... Medicare Extra for All plan. The bill would offer people a choice, allowing them to retain the plans they receive through their employers or move over to Medicare at their own pace." 22

2019-JUN-29: U.S. Caravan visits Canada to buy cheaper Insulin:

A group called "Caravan to Canada" left Minneapolis, MN and traveled to London, Ontario in Canada to purchase Insulin medication for Type 1 diabetes.

By visiting Canada, the Caravan went to the country where Sir Frederick Banting (1891-1941), John MacLeod, Charles Best, and their team at the University of Toronto in Ontario discovered Insulin as a treatment for diabetes during the early 1920's.

On 1920-OCT-31, Banting had prepared a lecture on the pancreas organ. He had a restless sleep, got up, and wrote down a 25 word hypothesis:

This resulted in research that led to the discovery of insulin. Prior to this development, diabetes was considered a death sentence. Banting and MacLeod won the Nobel Prize in Physiology or Medicine in 1923 for their work, which has since saved the lives of millions of people. Banting was angry that the rest of the team were not honored. So, Banting and MacLeod shared their prize money with the rest of the team. He was knighted by King George V in 1934. Banting was later voted the fourth "greatest ever Canadian" in 1989. World Diabetes Day is held yearly on NOV-14, which was Banting's birthday.

Author's personal note: I apparently inherited diabetes from one of my parents. I was diagnosed in the early 1990's. At the time, I worked for DuPont of Canada which had an in-plant medical department. They did a routine blood glucose measurement and found it was well above the normal maximum. I would probably be dead now if insulin hadn't been developed by the team at my alma mater. Insulin is free for me, along with glucose test strips, due to my health care plan.

Although Banting might have become a billionaire as a result of his discovery, he wanted insulin to be available to everyone. He said: "Insulin does not belong to me, it belongs to the world." So he sold the patent rights for insulin to the University of Toronto for $1.00!

Persons with diabetes require medication to control their blood glucose level. Often they take Metformin tablets when first diagnosed. However, many need to switch to insulin later in life. Blood glucose that is too high can leads to vision loss, confusion, nausea, seizures, and loss of consciousness, and PAD -- peripheral artery disease. PAD can lead to amputations of toes, feet and lower legs. When my glucose level is too low, it causes a general unwell feeling, shaking arms. It can lead to loss of consciousness and even death. I carry glucose tablets with me and a "I have diabetes" card 26 with me at all times.

The "Caravan to Canada" included Nicole Smith-Holt, whose 26-year-old son died in 2017. He wasn't able to afford the cost in the U.S. for the amount of insulin that he needed to control the disease. So he had to ration his injections, and subsequently died.

Quinn Nystrom, is a leader of the Minnesota chapter of T1International, a group that advocates for increased access to insulin in the U.S. She also led the Caravan. She said in May that the price in the U.S. of insulin per vial was USD $340 as sold by the three major brands that control the market. In Canada the same medication under a different name was sold at the equivalent of USD $23 -- without a prescription. 23,24 Presumably, Insulin at U.S. $23 generates a profit, so selling it at $320 must generate an obscenly high profit for the manufacturer. Nystrom said that one in four diabetic persons in the U.S. were rationing their insulin.

According to the BBC, the list prices of one vial rapid-acting insulin in the U.S. is:

Humalog: U.S. $275

Apidra: $284

Novolog: $289

Ritu Prasad writing for BBC News, said:

"... there are cheaper options in the US for some: WalMart insulin, for example, is a re-branded version of a Novo Nordisk formula which retails for around $25 per vial in most states. But the formula is older, less effective, and some, like Ms Marston, are allergic to it. 25

Persons with diabetes typically use from one to three vials a month. 25

More developments are inevitable.

U.S. Caravan visits References used:

The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.

Search Google.com for: "diabetes card" Caution: some cards have numbers on them indicating when blood glucose is too low or high. Unfortunately, the measuring units used in the U.S. are 18 times higher than in Canada. That could cause a disaster if the card doesn't match the country you are in.